Active NPI
Robert Richard Halvorsen, DMD
- Dentist
- Sandersville, GA
National Provider Identifier
1891865226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11547
- Practice address
- 504 Washington Ave
Sandersville, GA 31082-1981 - Phone
- (478) 552-6266
- Fax
- (478) 552-6009
- NPI assigned
- Nov 9, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11547 | GA | Primary |
Addresses
Primary practice location
504 Washington Ave
Sandersville, GA 31082-1981
Mailing address
925 Windmill LN
Evans, GA 30809-6609
Phone (706) 868-1548
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11547 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891865226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 WINDMILL LN",
"city": "EVANS",
"state": "GA",
"postal_code": "308096609",
"telephone_number": "706-868-1548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 WASHINGTON AVE",
"city": "SANDERSVILLE",
"state": "GA",
"postal_code": "310821981",
"telephone_number": "478-552-6266",
"fax_number": "478-552-6009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALVORSEN",
"first_name": "ROBERT",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "11547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.